Browsing tag: RAO

As vets, we’re always trying to do the very best for our patients. However, veterinary medicine is constantly changing – every year, hundreds, even thousands of new papers are published, new drugs become available, and new machines and tools come on the market. What was the “gold standard” of treatment for a disease ten years ago might now be proven to be more harmful than helpful! At a recent conference (BEVA Congress – see below for more on that…), John Walmsey, one of the foremost and best respected members of the profession, gave the plenary lecture talking about the massive changes that have taken place in equine veterinary care in the four and a half decades since he graduated. The drugs we have now are far more effective, the machines and tools more robust and more useful. Even ten years ago, MRI in the horse was really rare and (to be honest) unreliable; now it’s a standard tool in working up a complex lameness. As a result, with the field of knowledge constantly changing, it’s more important than ever for vets in practice to keep up!

The process of keeping up to date is known as CPD (Continuing Professional Development), and we are expected to do at least 5 days a year. It can be made up in a number of ways, including lectures, seminars, webinars, practical courses and reading journals and papers. Like most equine vets, I receive the big journals Equine Veterinary Journal and Equine Veterinary Education, which (respectively) publish papers on equine science and equine surgery and medicine. I also try to attend relevant courses and lectures as often as I can.

In September, I was at the BEVA (British Equine Veterinary Association) Congress in Birmingham. This is one of the biggest gatherings of horse vets in the world, and I try to go most years. Congress lasts for three days of lectures and seminars, as well as a large commercial exhibition. It’s a great place to go to pick up the latest ideas, new treatments and medicines, and catch up with colleagues from across the country. I sometimes think we learn almost as much from talking over cases with colleagues as we do in the lecture theatres!

This year was notable for…

The debate over firing of tendons. (Quick recap on that one – the Royal College, our regulatory body, does not permit firing of tendons etc; some equine vets think firing should be permitted again in certain circumstances; however, others disagree. The argument goes on!).

Andy Bathe from Rossdales in Newmarket had some hilarious stories about working at the Olympics, as well as a number of thought provoking points. For example, some of the showjumpers were receiving a wide range of different (legal) medications to keep them performing at their peak throughout the competition; and every single dose of every single medication had to be certified by an official vet on a separate form. That led to a HUGE pile of forms for the FEI vets to certify each day!

There was also a long session on current approaches to laminitis – unfortunately, none of the existing theoretical studies are an exact match for the real disease, and researchers are still plodding along, gathering information. Sooner or later, we will have a good understanding of the condition; however, at the moment we have to be content with identifying horses and ponies who are at high risk, and managing them to minimise the risk. There aren’t any easy tests available to measure how high the risk is, however, so it still comes down to the clinical judgement of the vet on the ground.

New work being done on RAO (Recurrent Airway Obstruction, what used to be called COPD). Almost all the vets in the audience, as well as the panel of experts, agreed that this year has been especially bad for summer pasture associated RAO, and that cases seem much more resistant to normal treatment than usual. No-one knows why, but it seems likely that the unusual weather has resulted in more pollen than usual (or at least, more of the particularly reactive pollens). One lecturer from Switzerland had a fascinating paper to present on the genetic basis of RAO – he and his team have identified at least 2 different genes that can cause it, one of which is also associated with extra resistance to worms and other parasites. Unfortunately, though, it looks like it will be a long time before there is a simple genetic test, because there are another 11 genes that are also involved… as usual with any horse disease, nothing is as simple as it at first appears! However, he did have one useful tip… In Switzerland, a horse with summer-RAO is routinely moved into the mountains, which seems to reduce the severity. Obviously, this isn’t always practical here, but one UK-based expert on the panel suggested moving to the coast for the same reason – to remove the horse from the source of the allergens that are causing the problem.

As well as the main lectures, there is always one lecture theatre devoted exclusively to Clinical Research – vets and scientists (and mostly people who are both) present their papers on all sorts of subjects, ranging from Soft Tissue Surgery to Reproduction to Imaging to General Medicine. If I tell you that papers presented include “Carbon Dioxide laser surgery with adjunctive photodynamic therapy as a treatment for equine peri-ocular sarcoid: Outcome and complications in 21 patients” and “Validation and reliability of orthoganal ultrasonographic projection dimensions of the kidney in the horse”, you should get some idea of the level of science being presented!

Of course, after Congress, every delegate takes home a copy of the Proceedings – a (big fat) book containing a summary of all the lectures and papers presented. In addition, all the lectures are recorded and vets can access them online, if there was a lecture in particular that they missed. For a lot of us, Congress is only the beginning – on the train home, or over the next few weeks, vets across the country will be reading up on papers and lectures in their particular areas of interest. At most practices – including mine – whenever anyone has been on a course or conference, they then have to boil it down into practical, “hands-on” information. We then present it to the other vets (and nurses etc, if it involves new techniques or machines), so that everyone’s patients can benefit from the new knowledge. Sometimes it’s hard – it can be very difficult for all of us to accept that a long-cherished treatment has been proven not to work! – but for the sake of all our patients, we work hard to use the most up to date information, and not to be trapped in old, comfortable ideas that aren’t as effective.

The other side of veterinary education, of course, is the education and teaching of students that happens in practice. I’ll be talking about that in my next blog!